Renal Artery Stenting - an Unnecessary Procedure?

Recently, the National Institutes of Health (NIH) published this article regarding renal artery stenting, a common surgical procedure to treat patients with renal artery stenosis. As noted in the article, renal artery stenosis occurs in 1 – 5 % of people who have hypertension, an extremely common disorder affecting approximately 78 million Americans. For those with hypertension who exhibit signs of renal artery stenosis, many times the renal arteries are stented, to prevent further injury to the kidneys. When untreated, renal artery stenosis can lead to chronic kidney disease, which comes with its own symptoms and comorbidities.

However, in the NIH news release above, the routine renal stenting procedure has been brought into question in a recent NIH-funded study, the results of which were presented in the New England Journal of Medicine in November. According to this publication, no significant benefit was shown “with respect to the prevention of clinical events when added to comprehensive, multifactorial medical therapy in people with atherosclerotic renal-artery stenosis and hypertension or chronic kidney disease”. The study, labeled CORAL for Cardiovascular Outcomes in Renal Atherosclerotic Lesions, was a randomized trial involving 947 participants throughout the U.S., Canada, South America, Europe, Australia, and New Zealand. This article nicely summarizes the study; after being randomized to medical therapy plus renal artery stenting or medical therapy alone, participants were followed for seven years to monitor for significant clinical events. The conclusion was that there was no significant in the outcomes between these two groups of patients.

Will this new information lead to a reduction in the number of renal stenting procedures? Will this have a significant affect on the medical device industry, or maybe just those companies who focus on the production of stents?